[08.23] Obstructive Disorders of the Male Urinary System V2.pdf

Presence of the prostate and a longer, segmented urethra

What are the two primary anatomical differences in the male urinary tract compared to females?

Prostatic, Membranous, Bulbar, and Penile

What are the four segments of the male urethra?

About 4 cm

What is the approximate length of the female urethra?

Leeway or compensation for injury

What is the benefit of the urinary tract having two sides?

Urolithiasis and Benign Prostatic Hyperplasia

What are the two common conditions for urinary tract obstruction in males?

Congenital, Acquired Intrinsic, and Acquired Extrinsic

What are the three general classifications of urinary tract obstruction causes?

Acquired Intrinsic

Under which classification does urolithiasis fall?

Benign Prostatic Obstruction (BPO)

What clinical diagnosis is more appropriate than BPH for describing prostate-related obstruction symptoms?

Benign Prostatic Hyperplasia

Which term refers specifically to pathologic findings in the prostate which may be less meaningful to patients?

Benign Prostatic Enlargement

What is the diagnosis for an enlarged prostate that is not currently obstructing?

Posterior urethral valve

What is a common congenital cause of lower urinary tract obstruction in the urethra?

Phimosis

What is an acquired intrinsic cause of urethral obstruction mentioned in the source?

Gravid uterus

What is an acquired extrinsic cause of renal pelvis or ureter obstruction related to pregnancy?

Urolithiasis

What is the formal medical term for urinary stone disease?

The kidneys

From where do most urinary stones originate before migrating down?

Stasis

What state encourages the formation of stones in cases of pre-existing obstruction like a stricture?

Pelvolithiasis or pelviolithiasis

What is the term for stones specifically located in the renal pelvis?

Ureterolithiasis

What is the term for stones located in the ureter?

Nephrolithiasis

What is the term for stones located in the kidney calyces?

Cystolithiasis

What is the term for stones located in the bladder?

Urethrolithiasis

What is the term for stones located in the urethra?

1 to 15 percent

What is the estimated lifetime prevalence of urolithiasis?

1.3

What is the male-to-female ratio for the incidence of urolithiasis mentioned in the source?

Dehydration and fluid losses

What factors contribute to stone formation in occupations with high heat exposure?

Hard water

What type of water in a residential area might contribute to the formation of urinary tract stones?

Obesity, hypertension, hyperglycemia, dyslipidemia, hypertriglyceridemia, and gout

What conditions are part of the metabolic syndrome associated with urolithiasis?

Insulin resistance

What is the underlying mechanism in metabolic syndrome associated with factors promoting stone formation?

Low urine pH (acidification)

What urine condition promoted by hyperinsulinemia encourages uric acid stone crystallization?

High calcium, uric acid, sodium, and phosphorus

What excretion factors in urine are promoted by insulin resistance to increase stone formation?

Calcium oxalate

What is the most common type of urinary stone formed due to metabolic syndrome factors?

Hypertension, myocardial infarction, stroke, and chronic kidney disease

Patients with urolithiasis are at a higher risk for which four comorbidities?

Once a stone former, always a stone former

What is the saying shared by Dr. Uy about the lifelong nature of urolithiasis?

Recurrence

Damage from what repeated event can lead to Chronic Kidney Disease in stone formers?

Saturation of ions or stone-forming salts

What condition of the glomerular filtrate leads to the precipitation and formation of crystals?

At least 2.5L

What is the minimum recommended daily urine production to help prevent stone formation?

More than 3L or around 12 glasses

What daily fluid intake does Dr. Uy generally recommend to prevent stones?

Nucleation

What is the first step in the process of stone formation?

Aggregation

What is the step where multiple crystals come together to form a larger mass?

Nidus

What term describes the starting point of a stone that attaches to epithelial cells in the tubules?

Free-Particle Theory and Fixed-Particle Theory

What are the two theories explaining how stones initiate in the nephron?

Free-Particle Theory

Which theory suggests crystals aggregate and grow while moving through the microscopic parts of the nephron?

Fixed-Particle Theory

Which theory suggests crystals adhere to damaged epithelium to continue aggregating and growing?

Randall Plaques

What are the whitish subepithelial plaques made of calcium apatite found at the renal papilla?

Renal papilla

What is the smallest, grossly visible structure of the kidney where Randall Plaques form?

The calyces

In which part of the kidney do most stones initially arise before getting dislodged to the renal pelvis?

Undersaturation, Metastable, and Unstable

What are the three states of saturation for solutions like urine?

Undersaturation

In which saturation state can existing small stones potentially dissolve?

Potassium citrate

What is an example of an inhibitor medication used to prevent crystallization?

Metastable

In which state is there an equilibrium of crystal formation and dissolution?

Metastable

Urine is described as being in what state relative to stone-forming salts because of the presence of inhibitors?

Unstable

Which state occurs with very little fluid intake and a high sodium diet leading to nucleation?

Inhibitors will no longer work

What happens to the effectiveness of natural inhibitors when urine reaches the unstable state?

Formation Product

At the point where nucleation occurs despite inhibitors, the concentration product is called what?

Magnesium, Citrate, Pyrophosphate, Nephrocalcin, Tamm-Horsfall protein, Bikunin, and Uropontin

List the seven naturally occurring inhibitors found in urine mentioned in the source.

Hyperuricosuria and hypercalciuria

What two urine conditions associated with gout lead to increased stone formation?

Struvite stones

Which stones are composed of magnesium ammonium phosphate?

Staghorn

What is the characteristic shape of struvite stones that fill the pelvocalyces?

Females

Struvite stones are more common in which gender?

Urease

What enzyme is produced by certain bacteria to break down urea into ammonium and phosphate?

Proteus mirabilis, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Staphylococcus aureus

Name the four bacteria commonly involved in struvite stone formation.

Primary hyperparathyroidism

What condition causes an increase in PTH leading to increased bone resorption and hypercalcemia?

Hypercalciuria

What is the ultimate urinary outcome of primary hyperparathyroidism that leads to nephrolithiasis?

Renal Tubular Acidosis Type 1 (Distal RTA)

Which condition involves metabolic acidosis and a failure to acidify urine due to collecting duct dysfunction?

70 percent

What percentage of patients with Distal RTA have nephrolithiasis?

Calcium

What is the most common mineral component of urinary stones, accounting for about 80 percent of cases?

Calcium oxalate

What is the most common specific type of stone based on mineral composition?

60 percent

What is the relative occurrence percentage of calcium oxalate stones?

Uric acid (7%) and Struvite (7%)

What are the two most common non-calcium containing stones besides cystine?

Cystine

Which stone composition accounts for approximately 3 percent of cases?

Purely uric acid stones

Which specific type of stone is most likely to dissolve medically through dissolution therapy?

Calcium

Stones that are visible on a plain X-ray most likely contain what mineral?

100 to 600 HU

What Hounsfield unit range on a CT scan suggests a higher likelihood of uric acid composition?

1000 HU

What Hounsfield unit range is typical for calcium-containing stones on CT?

Migration of a stone from the renal pelvis to the ureter

What event commonly causes acute upper urinary tract obstruction?

4 mm

What is the approximate diameter of the ureter?

Peristalsis

What rhythmic movement of the ureter contributes to the pain felt when a stone is passing?

Costovertebral angle, anterior sides, inguinal area, and genital area

Describe the general path of pain for a passing kidney stone.

Suprapubic or Hypogastric area

In what area is pain felt if a stone is located in the distal ureter?

Dysuria, Frequency, and Urgency

What three lower urinary tract symptoms are associated with obstruction near the bladder due to irritation?

Nausea and Vomiting

What symptoms result from distention of the renal pelvis stimulating nerves that share innervation with the stomach?

Hematuria

What is the term for blood in the urine caused by a stone scraping the urothelial lining?

Lithuresis

What is the term for passing a stone out of the body through the urine?

Renal atrophy

What can chronic stone obstruction lead to regarding kidney tissue?

Hydronephrosis

What is the term for the dilatation of pelvocalyces due to obstruction?

Fibrosis

What happens to the urothelium of the renal pelvis and calyces in chronic obstruction?

Thinning

What happens to the renal parenchyma in chronic obstruction?

Stasis, bacterial proliferation, and increased adherence

Recurrent UTI in chronic obstruction is brought about by what three factors?

NSAIDS

Which analgesic class can cause further injury to the kidneys and must be avoided if creatinine is elevated?

Bacterial resistance

Why is it important to know a patient's history of multiple antibiotic intakes when selecting treatment?

Acute pyelonephritis

What is the term for inflammation of the kidney often associated with urolithiasis?

Costovertebral angle tenderness

What physical finding should be elicited if pyelonephritis is suspected?

Kidney punch or percussion

What physical maneuver is used to elicit CVA pain?

Urinalysis, Serum creatinine, CBC, CT stonogram, IVP, and Ultrasound

List the six diagnostic examinations for upper urinary tract obstruction.

WBCs

What may be increased in the urinalysis due to inflammation even in the absence of infection?

Acute kidney injury

What causes an increase in serum creatinine during acute obstruction?

Leukocytosis

What CBC finding indicates significant inflammation from an acute obstruction?

Presence, location, size, and density

What four things does a CT stonogram check for regarding a stone?

Thinning of renal parenchyma and a dilated, tortuous ureter

What are two signs seen on CT indicating chronic rather than acute obstruction?

Intravenous Pyelography (IVP)

What imaging modality shows different phases of dye excretion and can outline filling defects?

Blunting

What term describes the loss of the normal "cupping" shape of calyces in IVP due to dilatation?